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Gerberding seen as new face of public health

Centers for Disease Control and Prevention

Posted: Monday, June 30, 2003

By Daniel YeeAssociated Press

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, stands outside the CDC in Atlanta. In the year since she took over the CDC, Gerberding has had to deal with SARS, the threat of bioterrorism and now monkeypox.John Bazemore/AP

ATLANTA - Dr. Julie Gerberding seems as comfortable behind the wheel of her weathered pickup as she is posing in a Chanel suit and Marc Jacobs heels in the pages of Vogue. She appears as confident studying diseases in an Atlanta lab as she is planning policy with Washington's political elite.

And in just a year, this woman from small-town South Dakota has restored the credibility of the Centers for Disease Control and Prevention while becoming perhaps the most visible U.S. health official since Surgeon General C. Everett Koop during the Reagan Administration.

A year ago, the CDC was seen as a slow-to-react agency better at compiling statistics than fighting disease and one that stumbled badly at communicating with doctors and the public during the 2001 anthrax attacks.

All that has changed with the agency's fast, up-front response to last summer's West Nile virus and this year's outbreaks of SARS and monkeypox. Gerberding herself has fielded the on-camera questions.

''Koop, by far, is the gold standard about public visibility, about leading a country through a crisis,'' said Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health. ''She's likely to be the next most visible person, I think. She's become a clearly more visible figure than the (current) surgeon general,'' Richard Carmona.

The CDC was created in 1946 under the name Communicable Disease Center when malaria was a huge postwar problem in the Southeast. In nearly 60 years, no CDC director has weathered as many crises as Gerberding has in her first year.

When she was appointed last July 3, the West Nile virus was on its way to infecting 4,100 Americans and killing 284.

''Her whole attitude was one of 'How can we help?' as opposed to interrogating us with, 'Are you doing enough?' That makes a huge difference,'' said Marsanne Golsby, Louisiana Gov. Mike Foster's press secretary, commenting on Gerberding's visit during the height of that state's crisis.

Then, with fear of terrorism high, the administration ordered the CDC to make sure the country's health workers were immunized against smallpox, a disease that Americans hadn't seen in decades. Gerberding had to allay concerns within the medical community about the demands of the White House. She posed for photos while getting her own vaccination.

Then came the SARS virus, which catapulted Gerberding into the spotlight as an even-keeled, knowledgeable health chief who sought to inform the public while addressing people's fears.

''We learned through anthrax that, particularly in times of crisis, our nation wants to hear health information from credible sources,'' she said.

Her interviews were seen, heard and read around the world. Canadian Health Minister Anne McLellan wondered aloud why her country didn't have a similar agency - or a Gerberding.

''Dr. Gerberding became the public face'' of information on SARS for both Americans and Canadians, McLellan said.

Now the CDC is working to contain another high-profile outbreak: monkeypox, a cousin of smallpox.

''Her leadership and the CDC's capabilities have been tested under fire and they have responded very well,'' said Dr. Jim Curran, who helped the CDC fight AIDS in the 1980s and who is now dean of Emory University's Rollins School of Public Health.

''Even though all is not well, you feel like somebody competent is in charge.''

But that wasn't always the case. The government's handling of the 2001 anthrax attacks sullied the agency's reputation so much that some in Congress questioned whether the CDC ever could be trusted to competently run a disease investigation again. Resignations followed, including then-director Dr. Jeffrey Koplan, a respected insider.

During the anthrax scare, the agency was slow not only to get information out to state health officials, but to doctors as well, said Dr. Georges Benjamin, a former Maryland Secretary of Health who heads the American Public Health Association.

But along came Gerberding, a rising star within the agency whose job was to oversee hospitals' infection control measures. She was able to successfully tiptoe through the minefield of demands from the public, the medical community, Washington and the media.

What Koop did for public health communication during AIDS came back to haunt public health decades later.

''The elected political leaders were not as happy with Koop as the rest of the nation. Koop made the decision to independently act on AIDS and Reagan was not as willing to act,'' Blendon said. ''People have reined in the surgeon general after Koop. I don't think they have allowed them the air time.''

When anthrax hit, Surgeon General Dr. David Satcher, a former CDC director, initially stood on the sidelines, even though the health crisis demanded a national health spokesman.

''On Day One of anthrax, why wasn't David Satcher ... made the C. Everett Koop of anthrax?'' asks Robert Howard, a former CDC communications official who left the agency in November 2001, a month after the anthrax attacks. ''You could have done the same thing with bioterrorism that you did with AIDS. We had a David Satcher and we didn't use him.''

From inside the heart of the CDC - the National Center for Infectious Diseases - Howard saw what he said was a ''complete disconnect,'' that conflicting reports and data from the CDC and the government ''kept bumping into each other. You couldn't find a solid, articulate message.''

What the government lacked was a Rudolph Giuliani, the mayor who held New York City together after Sept. 11.

''I kept looking for the Giuliani,'' said Howard. ''It wasn't until they started using Julie as a spokesperson for the agency - then they started using Dr. Satcher - that you began to get that level of confidence back.''

A Health and Human Services spokesman said Satcher actually spoke more than a week on anthrax before Gerberding did.

Those familiar with Gerberding say she comes across well because she doesn't play a part when the cameras are on. She relays scientific facts in an understandable way and admits it when the agency does not have the answer.

''What you see with Julie is what you get, it's incredible,'' says Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

''She's intelligent, she's charming, she's nice to be around,'' says her boss, Tommy Thompson, Secretary of the Department of Health and Human Services. ''She's a hard worker and has an outstanding vision that's good for the CDC and good for the department.''

Friends say she developed an interest in medicine early because of a love for animals, announcing when she was just 4 that she would be a doctor.

Despite her role as agency director, she sees patients when possible. Last month, visiting San Francisco General Hospital, she treated people with a variety of health problems, ranging from diabetes to alcoholism.

In Atlanta, she has surrounded herself with a core of advisers to help manage the agency, as she had no experience running an organization with 8,000 employees. She is paid $172,000 a year.

''This is a real step up for her - both Secretary Thompson and I had some concerns,'' says Oz Nelson, former United Parcel Service chief who is board chairman of the CDC Foundation, a nonprofit that raises money for agency improvements.

''You can't supervise everybody,'' Nelson said. ''But you learn how to manage through people and you learn what you have to do yourself.''

Gerberding enlisted Nelson and others into a team that has started to move the agency toward a focus on its ''customers'' - such as the public, other health departments and the media.

''I love changing organizations, I love trying to see ... what could be done to be really better,'' Gerberding says.

She views herself as a ''revealer,'' whose role is to tell the world about her staff - the best health experts in the world.

''I tell the stories of the important work that's being done here. I have the easy job.''

Gerberding, 47, gets away from the pressures of her job by gardening, a key reason she drives her ''little white truck.'' The garden is filled with native species, including ferns and azaleas.

Within the CDC, Gerberding quickly overcame the stigma of being an outsider. She is not an officer in the U.S. Public Health Service's Commissioned Corps (the scientists who wear the naval-style uniforms at media briefings); she never served in the elite Epidemic Intelligence Service, a two-year program that trains the disease detectives who are dispatched around the world.

Before joining CDC in 1998, Gerberding had been the director of an infection control teaching and research program at the University of California at San Francisco. She served on the frontline of the AIDS crisis, treating patients and working to make sure HIV infections did not spread.

''I have had a lot of experiences that put tools in my toolbox that have allowed me to do some things here that I think I was really prepared to do,'' she said.

Koplan was the CDC's ultimate insider. He was a former EIS officer, held the rank of rear admiral in the Commissioned Corps and was a part of the agency's legendary eradication campaign of smallpox, the only infectious disease in history that mankind has removed from the planet. His boyish charm and humor can quickly captivate an audience filled with doctors and doctorates.

But he was captain when the agency ran aground.

''I think Jeff was strong with the press but got caught up in the anthrax issue,'' said CDC Foundation president Charlie Stokes. A combination of forces, he said, created an ''unjustified perception that CDC wasn't answering the public like they should.''

Initially seen as a political choice by some agency watchers, Gerberding increasingly has won admirers with her ability to make tough decisions and convey an easy-to-understand health message.

But bringing respectability back to the agency isn't enough.

''I always strive for excellence,'' she says. She looks forward to a time when the CDC is more adaptabme and flexible to outbreaks and when CEC research granus will one eay carry the same prestige as National Institutes of Health projects.

If she's successful, the impact will be far-reaching.

As Stokes puts it: ''There's no better stage from which to make a difference in the world of health than as director of the CDC.''